- 學位論文
衛教手冊合併電話護理諮詢對冠心病高危險群防治之認知、健康信念、預防行為及生化指標之改善成效
The Effect of Health Education Programs on Improving Coronary Artery Disease Preventing Knowledge, Health Beliefs, Behaviors, and Health Status Among High Risk Group
摘要
本研究旨在探討衛教手冊合併電話護理諮詢對冠心病高危險群於防治冠心病之認知、健康信念、預防行為及生化指標（血壓、血糖及血膽固醇）的改善成效。採類實驗研究設計，以台北市某社區三合一篩檢任一項檢驗異常的個案，採隨機分配方式編為實驗組（n =57）與控制組（n =58），以結構式問卷進行冠心病相關的認知、健康信念、預防行為之前測，實驗組給予衛教手冊，並於收案後一、四及十週，給予電話護理諮詢，於十週後再收集所有研究對象相關變項之改善成效。完成前後測的實驗組與控制組個案分別為43人及41人。 本研究對象平均為64.7歲（SD =8.82），兩組皆以女性居多，多數女性研究對象皆已停經，及未使用避孕藥或荷爾蒙，兩組研究對象皆以理想體重、已婚、有家族史居多。實驗組教育程度較控制組為高。實驗組與控制組分別有8.8%及15.5%個案目前仍在吸菸。研究發現兩組除實驗組在女性腰圍部份顯著大於控制組外，其他基本人口學變項皆具同質性。 前測結果顯示研究對象對冠心病防治有關的認知屬中上程度（M =56.59, SD =21.84）；健康信念屬較為正向（罹患性認知：M =2.46, SD =0.70；嚴重性認知：M =3.39, SD =0.60；有效性認知：M =3.31, SD =0.57；障礙性認知：M =1.52, SD =0.72）；預防行為（M =2.33, SD =0.72）則仍有很大的改善空間。在生化指標方面，兩組研究對象除膽固醇平均值皆略高於標準值外，其餘生化指標均在正常標準值之內。此外，兩組研究對象異常人數及平均值未達統計上之顯著差異，具高度同質性。 經十週介入後：（一）實驗組之冠心病認知（t = 8.91, p < .001）、健康信念之罹患性認知（t = 4.16, p < .001）、嚴重性認知（t = 4.08, p < .001）、有效性認知（t = 4.49, p < .001）與障礙性認知（t = - 3.51, p < .01）、預防行為（t = 7.27, p < .001）、飯後血糖（t = -2.34, p < .05）及膽固醇（t = -3.48, p < .01）有顯著改善成效；（二）後測實驗組冠心病防治之認知（t = 5.25, p < .001）、罹患性認知（t = 4.60, p < .001）、有效性認知（t = 2.97, p < .01）及預防行為（t = 4.41, p < .001）進步情形顯著優於控制組；（三）兩組研究對象在血壓、血糖及膽固醇進步情形未達顯著差異；（四）研究對象對冠心病認知與健康信念間呈現顯著相關，且冠心病認知亦與預防行為間呈現顯著相關；而研究對象對防治冠心病的態度以健康信念模式測量發現，除嚴重性認知未與預防行為呈顯著相關外，其餘皆呈現顯著相關。 根據本研究結果得知，以電話護理諮詢合併衛教手冊介入可有效改善研究對象之冠心病防治認知、健康信念及預防行為，建議可將本模式推廣至衛生所或醫療院所，使得此冠心病高危險族群能被早期發現，早期介入及追蹤，進而達到疾病預防的目的。
並列摘要
This study aimed to examine the effect of health education programs (education brochure combined telephone consultation) on improving Coronary Artery Disease (CAD) preventing knowledge, health beliefs, behaviors, and health status (blood pressure, blood sugar and cholesterol) among its high risk population. The quasi-experimental design was utilized and randomly assigned to recruit 57 (experimental group) and 58 (control group) subjects from the community screening program in Taipei. The education brochure was mailed to subjects in the experimental group; and the telephone consultations were offered at the first, fourth, and tenth week. The structural questionnaire and health screening instruments were used to collect pre- and post- test changes between groups. The total of 43 and 41 subjects in experimental and control groups completed the study. The average age of the cases were 64.7 (SD = 8.82). The majority of subjects were married, female, within post menopausal state, in ideal body weight, and with family history of chronic diseases. The homogeneous analyses indicated that almost every attributes were similar except the female subjects waist circumference was slightly higher in experimental group. Results of the baseline analyses revealed that subjects had median level of knowledge (56.59±21.84); positive attitude (2.46±0.70 in susceptibility; 3.39±0.60 in seriousness; 3.31±0.57 in benefits; 1.52±0.72 in barriers); and low prevention behaviors (2.33±0.72). Subjects were basically normal besides with higher cholesterol values in both groups. Otherwise, there was no significant statistical difference between groups. After intervention, the study results were as followed. (1) the CAD’s knowledge (t = 8.91, p < .001), perceived susceptibility (t = 4.16, p < .001), seriousness (t = 4.08, p < .001), benefits (t = 4.49, p < .001) and barriers (t = - 3.51, p < .01) in health belief, preventing behaviors (t = 7.27, p < .001), the after meals blood sugar (t = -2.34, p < .05) and cholesterol (t = -3.48, p < .01) were improved significantly in the experimental group using the paired t tests. (2) In post-tests, the experimental group’s knowledge of preventing CAD (t = 5.25, p <.001), perceived susceptibility (t = 4.60, p <.001), perceived benefits of taking action (t = 2.97, p <.01) and preventing behaviors (t = 4.41, p <.001) were better improved than that of the control group. (3) the progress of blood pressure, blood sugar and cholesterol didn’t reach the level of great improvement. (4) The knowledge and health beliefs of CAD were highly correlated and so were the knowledge and preventing behaviors of CAD. Using the Health Belief Model, the perceived susceptibility, perceived benefits and perceived barriers of taking action were all significantly related to preventing behaviors. Results of this study indicated that education brochure combined with telephone consultations were effective in improving the subjects’ CAD prevention knowledge, health beliefs and behaviors. This health education programs will be recommended to various health institutions to early detect and treat CAD high-risk population.